FORM 1023-EZ for PEDIATRIC VICTORY FOUNDATION

Field Data
EIN 81-2501839
Case Number EO-2016319-000682
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEDIATRIC VICTORY FOUNDATION
Organization’s Mailing Address 4520 CALLADA PLACE
City TARZANA
State CA
ZIP 91356
Accounting period End 5
Primary contact name MONIQUE ROSENTHAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MONIQUE ROSENTHAL
PRESEDENT
4520 CALLADA PLACE
TARZANA CA 91356

Officer/Director/Trustee Two

HOWARD ROSENTHAL
VICE PRESEDENT
4520 CALLADA PLACE
TARZANA CA 91356

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H96 - Neurology, Neuroscience Research
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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